Name of Grant Program: Massachusetts 21st Century Community Learning Centers
Fund Code: 647-B1
– Supporting Additional Learning Time (for new ELT and OST sites)
Part III-A – Required Program Information – District (FY17)
Please see the Funding Opportunity-Request for Proposals (FO-RFP) for additional information including:
minimum eligibility requirements, allowable models for adding time, maximum funding request amounts and
priorities for the use of grant funds.
Instructions for completing this document:
 Questions are labeled as follows to indicate which applicants should respond, according to the model
chosen for the respective site:
o [ALL] – All applicants should respond.
o [Model 1 (ELT) ONLY] – Only districts applying for Model 1 (ELT) sites should respond.
o [Model 2 (OST) ONLY] – Only districts applying for Model 2 (OST) sites should respond.
 Questions primarily focus on planning and implementation of school year programming. Funded
applicants will be asked to more fully describe summer programming in the mid-year reporting.
 Responses should be provided within this document leaving the questions above each response. All
questions are shaded in gray and responses should be written in the white space below each question.
 Please do not delete questions that are not applicable – this will re-number questions and may lead to
confusion in responding to questions that reference earlier questions.
 Please adhere to indicated page limits and do not change the font size or margins.
 Narrative and/or bulleted responses are acceptable.
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Name of Grant Program: Massachusetts 21st Century Community Learning Centers
Fund Code: 647-B1
– Supporting Additional Learning Time (for new ELT and OST sites)
I.
DISTRICT COVER SHEET
IMPORTANT NOTE: If the lead applicant is not a district, it must work with the applicable district(s) to complete
this application.
Information on this page (and from pages 2 and 3 in Part III-B) must be completed here AND submitted
online using this link:
http://www.surveygizmo.com/s3/2491770/FY17-Fund-Code-647-B1-21st-CCLC-Grant-General-Information
Lead Applicant
(District/Agency):
District/Agency Contact
Name and Title:
Phone:
Proposed
School(s)/Site(s)
Include below all
schools/sites proposed in
this application. Insert
rows as needed.
Email:
Model for Adding Time
Please place an ‘x’ in the appropriate
box for each school/site proposed.
Model 1 (ELT)
Amount Requested
School
Year
Model 2 (OST)
Total Request
Summer
Total
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Please indicate the district’s* % of students who are economically disadvantaged (ED) in
2015-2016:
Competitive Priority:
(Please put an ‘x’ in the
box if applicable)
[Model 2 (OST) Applicants Only] Districts/lead applicants or communities
that have not received 21st CCLC funding within at least the past three
years (FY14-FY16).
*If the lead applicant is not the school district, please use the ED percentage of the district in which the majority of students
served in the program are enrolled.
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Name of Grant Program: Massachusetts 21st Century Community Learning Centers
Fund Code: 647-B1
– Supporting Additional Learning Time (for new ELT and OST sites)
II.
District Summary
District Process and Rationale for Adding Time (3 pages maximum):
1. [ALL] Identify the elements of the district’s i existing improvement, turnaround, and/or other strategic plans
that will be addressed through the proposed ELT and/or OST programming. Note: The response to this
question should provide a general overview for the district. School-specific needs/priorities will be described
in Part III-B.
2. [ALL] Describe previous experience running ELT and/or OST programs (regardless of funding source).
Include a description of how lessons learned from these experiences have informed the program design for
the site(s) included in this application.
2a. [Model 2 (OST) ONLY - if the proposed school(s)/site(s) received 21st CCLC OST funding during any of
the following years: FY12-FY15]). Did the school(s)/site(s) continue to operate an OST program(s) after the 21st
CCLC funding cycle ended, even if at a reduced level?
Yes?
No?
If yes, briefly describe the current program.
If no, explain why not.
District Support and Sustainability (5 pages maximum):
3. [ALL] Describe how the district/lead applicant, the proposed school(s)/site(s), and partners (if applicable) will
collaborate to support implementation of ELT and/or OST, including to make related budgetary decisions.
4. [ALL] Describe the qualifications/credentials the program will seek for the required coordinator position. If the
district currently has a person that will serve in such a role, describe that person’s qualifications/credentials.
Reminder: Applicants must designate a full- or part-time coordinator whose primary role is to oversee grant
implementation. (See Addendum A – Grant Assurances)
5. [ALL] Describe the membership and roles of the required district-level community council and how it is/will be
representative of the school district boundaries, community, and populations to be served. (See Addendum A
- Grant Assurances for recommendations on council membership.)
What is the current status of the community council?
Newly formed?
Part of an existing council?
Will be formed if funded?
6. [Model 1 (ELT) Only] Describe plans to support the costs associated with implementing the proposed longer
school day that will not be covered with grant funds. If applicable, include plans for negotiating collective
bargaining agreements to maximize financial support for the longer schedule. Reminder: Grant funds must
be used to support the enhancement or addition of engaging academic enrichment and/or intervention.
7.
[ALL] Describe the initial steps/process that the district will undertake to develop a long-term sustainability
plan for ELT and/or OST. Include the following:
 The role of the community council in the sustainability planning process;
 The role of district-level partners with shared priorities that will support the success, affordability and
sustainability of programming. (For example, partners who are working with multiple schools/sites and
are contributing resources (staff, funding, etc.) to the program.); and
 Information about planned or anticipated coordination with and/or support from other federal, state or
local programs and grants (e.g. Title Iii, Title III, Wraparound Services, Early Education and Care
contracts/vouchers, etc).
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Name of Grant Program: Massachusetts 21st Century Community Learning Centers
Fund Code: 647-B1
– Supporting Additional Learning Time (for new ELT and OST sites)
i
If the lead applicant is not the school district, please describe the district improvement, turnaround and/or other
strategic plans of the district from which the majority of students served in the program are enrolled.
ii
Level 2-5 districts are permitted to use their Title I, Part A reservation funds [formerly supplemental educational
services (SES) and public school choice set-aside funding] to support district/student needs as assessed in
relation to the Conditions for School Effectiveness. This means that a district can choose to direct part or all of its
Title I, Part A allocation (which could also include Title II, Part A funds flexed into Title I, Part A) to support
additional time in one or more schools, if the district determines that will best meet the needs of the district's
lowest performing students. If Title III funds are currently used for services to English language learners during
OST or summer, those funds may also be coordinated with 21st CCLC funds to maximize resources
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